Body representation and sensorimotor function as agents for brain reorganization and behavior change: from chronic pain to immobility and dementia

参与疼痛处理和身体表征的大脑回路紧密相连，相互作用比以前想象的要多。躯体感觉、视觉、内感受和运动过程有助于身体知觉的形成，并且可以结合在旨在重建正常身体表征的治疗中。基于针对幻肢痛身体表征的新型心理干预措施的发展，我们设计了新的基于虚拟和增强现实的训练程序，以重建正常的身体表征并改善感觉，运动和认知功能。我们将这些干预措施应用于损伤后疼痛和运动功能障碍，通过运动反馈抵消长期不动应缩短恢复时间并保留肌肉功能。另一个新的应用是在慢性肌肉骨骼疼痛，其中完整的身体表征，包括内感受的系统塑造，应该减少疼痛和疼痛行为，并改变适应不良的脑回路。我们将这种方法扩展到早期痴呆症，其中感觉运动处理和不动性的崩溃可能在疾病进展中很重要。我们采用新的隐式和显式的评估方法，这些感知和神经元的变化，涉及心理物理学，计算建模，生理记录和脑成像方法。这些研究是机械治疗方法的基础，也推动了身体表征和多感觉整合的基础研究。

Brain circuits involved in pain processing and body representation are closely connected and interact more than previously thought. Somatosensory, visual, interoceptive and motor processes contribute to the formation of body perception and can be combined in treatments designed to reestablish normal body representation. Based on the development of novel psychological interventions targeting body representation in phantom limb pain, we devise new virtual and augmented reality-based training procedures to reestablish normal body representation and improve sensory, motor and cognitive function. We apply these interventions in post-injury pain and motor dysfunction, where the counteracting of long-term immobility by feedback of movement should shorten recovery times and preserve muscle function. Another novel application is in chronic musculoskeletal pain, where the systematic shaping of intact body representation including interoception, should reduce pain and pain behaviors and alter maladaptive brain circuits. We expand this approach to early dementia, where the breakdown of sensorimotor processing and immobility may be important in disease progression. We employ novel implicit and explicit assessment methods of these perceptual and neuronal changes involving psychophysics, computational modeling, physiological recordings and brain imaging methods. These studies are the basis for mechanistic treatment approaches and also advance basic research on body representation and multisensory integration.